Sarcoid Reaction Research Articles

Checkpoint inhibitor-induced sarcoid reaction mimicking bone metastases

Checkpoint inhibitor-induced sarcoid reaction mimicking bone metastases

Usefulness of EBUS-TBNA in the Staging of Lung Cancer in Patients with Sarcoidosis and Sarcoid Reactions

目的．サルコイドーシスやサルコイド反応は肺門・縦隔リンパ節腫大を呈し，これらを合併した肺癌症例には，リンパ節病変の評価が治療方針決定上で問題となる．本研究では，これらサルコイド反応合併肺癌症例の病期診断におけるEBUS-TBNAの有用性を検討した．対象と方法．2009年1月から2016年12月に気管支鏡検査を実施され，サルコイドーシス/サルコイド反応と肺癌の合併と診断された症例におけるEBUS-TBNAの有効性について検討した．結果．EBUS-TBNAにより，サルコイドーシス/サルコイド反応と肺癌との合併と診断された症例は4例であった．造影CT，FDG-PET/CTでは癌のリンパ節転移とサルコイドーシス/サルコイド反応の鑑別は困難であった．4例中3例はI期の非小細胞肺癌と診断され，2例は手術が施行された．術後検体でも転移はなく，granulomaが認められたことから，サルコイド反応と診断された．4例中1例は全身性サルコイドーシスに合併したIII期の肺癌症例であった．結論．サルコイドーシス/サルコイド反応合併肺癌症例におけるN因子の評価に，EBUS-TBNAは有用であると考えられる．

Cutaneous sarcoid reaction in a case of acute lymphoblastic leukemia

Sarcoid reactions are noncaseating granulomas that simulate sarcoidosis. Since they do not fulfill the rest of criteria to diagnose systemic sarcoidosis, they have a separate identity. They are often reported in draining lymph nodes of malignancies. However, they can also occur in the skin forming “Cutaneous sarcoid reaction” – such as this case. We report the case of a 17-year-old female with itchy, papules persistent for 3 months while she had no other complaint. The papules were present on the trunk and lower extremities. General examination was unremarkable except for cervical lymphadenopathy. Bone marrow aspirate and biopsy revealed features of “acute lymphoblastic leukemia (ALL)”. As the peripheral blood smear showed no blasts, it was hard to diagnose her leukemia. Skin biopsy showed features of granulomatous reaction simulating sarcoidosis. Her final diagnosis was compatible with “aleukemia form of ALL”. The patient was started on chemotherapy and her itching was relieved with treatment. The skin papules were resolved leaving behind hyperpigmentation. The link between sarcoidal reactions and malignancies still needs further research. However, cutaneous sarcoidal reactions may be the first presentation of systemic malignancy. Patients presenting with sarcoidal reactions should be investigated to exclude the associated malignancy.

Necrotizing sarcoid granulomatosis with clinical presentations of recurrent acute abdomen. Case report and literature review

The authors have described the world's first case of necrotizing sarcoid granulomatosis (NSG) in a 22-year-old woman with the clinical presentations of acute abdomen, which are associated with abdominal lymph nodal infiltration and necrosis, obvious constitutional disturbances (fever, nocturnal sweats, and significant weight loss), high inflammatory activity (anemia, leukocytosis, high erythrocyte sedimentation rates and C-reactive protein levels), the gradual appearance of splenic and hepatic necrotic foci, and infiltration into the lung and lacrimal glands with the development of unilateral uveitis. The patient underwent five surgical interventions, several needle biopsies for recurrent abdominal syndrome, and long-term antibiotic treatment for presumed sepsis, which had caused drug-induced hepatitis. Bacteriological examination of blood, puncture samples, and removed abdominal cavity tissues, serological tests, and immunomorphogical study of biopsy samples and removed tissues yielded negative results for the presence of bacterial, fungal, and tuberculosis infections. NSG was diagnosed on the basis of the systemic nature of the lesion, the presence of granulomas with severe abdominal lymph nodal necrosis and necrotizing granulomatous/lymphocytic vasculitis in the mesentery and removed spleen, as well as the absence of granulomas in the spleen, appendix, and biopsy materials of the liver, colonic mucosa, and parotid gland. Fludarabine therapy was first used in world practice due to the inefficient treatment with high-dose glucocorticoids and cyclophosphamide and to a disease relapse when reducing their doses. The paper gives a detailed review of the literature on the clinical, laboratory, radiological, and morphological manifestations of the disease, which allow the differential diagnosis of NSG with different variants of granulomatous lesions. Based on the 5-year follow-up of the patient and on the analysis of clinical, laboratory, radiological, and morphological changes, the authors uphold the concept that the disease is an independent nosological entity: necrotizing angiitis with sarcoid reactions, rather than the entity of nodular or classic sarcoidosis.

Questioning the Connection Between Sarcoidosis and Gastrointestinal Carcinoid Tumors

A 52-year-old African-American male with a past medical history of hypertension and hyperlipidemia presented to the hospital with a 7-10 day history of fatigue, malaise, fever, and cough productive of greenish sputum. His symptoms resolved with a course of Levaquin. His workup revealed lymphadenopathy on chest xray, so he underwent a CT scan and an eventual PET scan demonstrating extensive mediastinal and bilateral hilar lymphadenopathy along with multiple small lung nodules measuring up to 5 mm in the right upper lobe. There was also thickening along the mid to distal esophagus with presence of an adjacent 1.3 cm paraesophageal lymph node. Gastroenterology was consulted for endoscopic evaluation of the esophageal abnormalities. Esophagogastroduodenoscopy (EGD) was performed and revealed a normal esophagus and stomach, but a 2 cm nodule in the duodenal bulb. Biopsy was consistent with well differentiated neuroendocrine tumor (carcinoid). EUS with fine needle aspiration and biopsy was performed on the subcarinal and paraesophageal lymph nodes. Both nodes showed small compact granulomas without necrosis, consistent with sarcoidosis. Complete workup for infectious etiology, including bacterial and AFB cultures, was negative. The association between systemic sarcoidosis and malignant neoplasms has been reported before, but the relationship specifically between carcinoid tumors and sarcoidosis is yet to be detailed. Literature review did not reveal reports of concurrent sarcoidosis and gastrointestinal carcinoid tumors; however, there have been reports of sarcoidosis and pulmonary carcinoid. Levy et al 1997 report a case series of several patients who were encountered at Mayo Clinic with both sarcoidosis and carcinoid tumors. As with our patient, their series was unable to determine the chronology of events in which these two conditions occur. There remains controversy as to whether sarcoidosis predisposes patients to carcinoid tumors or whether it is the tumors that cause a sarcoid reaction. Our case provides suggestion that an association between extrapulmonary carcinoid tumor and sarcoidosis may exist.

Pulmonary Sarcoidosis in Behçet's Disease Treated with Adalimumab.

TNF-α antagonists are used to treat various rheumatic diseases including sarcoidosis. However, there have been increasing reports of sarcoidosis in relation to treatment using these drugs. The pathogenesis of this reaction remains unknown.This is a report of a clinical case of sarcoidosis in Behçet’s disease (DB) with mucocutaneous and intestinal involvement in treatment using adalimumab, with improvement after anti-TNF suspension and corticosteroid therapy.LEARNING POINTSThis clinical case demonstrates the efficacy of the anti-TNFa adalimumab in the treatment of Behçet with intestinal manifestations and not responsive to other therapeutics.To our knowledge it is the first time it is described a case of sarcoid reaction in a patient with Behçet treated with adalimumab.It shows how two complications of the use of immunosuppressants (sarcoid reaction and Legionella pneumophila pneumonia) in the same patient can difficult the correct diagnosis because of the many and overlapping clinical manifestations.

Sarcoid reaction in the spleen after sigmoid colon cancer resection: a case report.

BackgroundA sarcoid reaction is a phenomenon characterized by histologically proven granulomatous lesions without evidence of sarcoidosis. This pathology is a benign tumor itself, but several reports have described sarcoid reactions accompanying malignant tumors. Sarcoid reactions occur in various cancers, such as skin, lung, ovary, stomach, and breast cancers. However, only a few published reports have described sarcoid reactions in patients with colorectal cancer.Case presentationA 76-year-old woman underwent laparoscopic sigmoidectomy for sigmoid colon cancer. The postoperative follow-up computed tomography and 18-fluorodeoxyglucose positron emission tomography–computed tomography findings were suspicious for splenic metastasis of the sigmoid colon cancer. The patient then underwent laparoscopic splenectomy. Histopathological examination of the resected lymph nodes and spleen showed a non-caseating epithelioid cell granuloma. The patient was diagnosed with a sarcoid reaction.ConclusionsTo our knowledge, this is the first report of a sarcoid reaction in the spleen and regional lymph nodes after colon cancer resection. The effect of a sarcoid reaction on the prognosis in patients with colorectal cancer has not been fully determined because of the small number of such cases. Further analyses involving a larger number of cases are necessary to evaluate the relationship between sarcoid reactions and prognosis in patients with colorectal cancer. We herein present an extremely rare case of a sarcoid reaction in the spleen and regional lymph nodes.

所属リンパ節にサルコイド反応を伴った,末梢気管支に発生したEndobronchial hamartomaの1例

所属リンパ節にサルコイド反応を伴った,末梢気管支に発生したEndobronchial hamartomaの1例

Significance of coexistent granulomatous inflammation and lung cancer

AimsCoexistence of lung cancer and granulomatous inflammation in the same patient confuses clinicians. We aimed to document the prevalence, clinicopathological features, treatment outcomes and prognosis in patients with coexisting granulomatous...

Transient Sarcoid Reaction to a Thoracic Schwannoma

Background: Sarcoid reactions to benign tumors are an exception. Only two cases have been reported where these reactions were associated with a benign teratoma. We report a new case where a sarcoid reaction is secondary to a thoracic schwannoma. Observation: During a uveitis assessment performed on a 53 year-old man who was not displaying any other symptoms, a thoracic schwannoma and mediastino-hilar lymph nodes were fortuitously discovered. Surgical resection of the schwannoma leads to a regression of the mediastinal and hilar lymph nodes without any other medical treatment. Conclusion: In case of thoracic schwannoma, a sarcoid reaction must be considered if mediastinal lymph nodes are present. Other similar cases are necessary to confirm the validity of this case report.

Evaluation of Mediastinal Lymph Nodes in Sarcoidosis, Sarcoid Reaction, and Malignant Lymph Nodes Using CT and FDG-PET/CT.

The aim of this study was to analyze the clinical, computed tomography (CT), and positron emission tomography (PET) findings of sarcoidosis, sarcoid reaction, and malignant lymph nodes (LNs) to the results of transbronchial LN aspiration and biopsy (TBNA).The TBNA results of mediastinal and hilar LNs of 152 patients in our hospital from July 2008 to March 2013 were retrospectively reviewed. Two independent radiologists measured the size and attenuation of LNs on CT and assessed the probability of the 3 categories: sarcoidosis (n = 36), sarcoid reaction (n = 25), or malignant LNs (n = 91). The total volume and attenuation of LNs were measured using Image J (NIH). The median maximum standardized uptake value (maxSUV) of the 3 mediastinal and hilar LNs on PET/CT was obtained.There was no significantly different CT finding between sarcoidosis and sarcoid reaction. Multivariate analysis showed that the age, total volume of LNs, and number of enlarged LNs significantly differed between sarcoid reaction and malignant LNs. Sarcoid reaction tends to be occurred in young patients (P = 0.007), the total volume of LNs was smaller (P = 0.04) than that of malignant LNs, and there were significantly more LNs >1 cm (P = 0.005). The median maxSUV of the 3 highest SUVs of the LNs did not significantly differ between the 3 entities.

Four Decades of Necrotizing Sarcoid Granulomatosis: What Do We Know Now?

In the 4 decades since Dr Averill A. Liebow introduced necrotizing sarcoid granulomatosis, there have been publications of numerous cases, but its nature and possible relationship to classical and nodular sarcoidosis have been and remain controversial. Liebow introduced necrotizing sarcoid granulomatosis as a provisional diagnostic term and stated that "the problem is whether the disease represents necrotizing angiitis with sarcoid reaction, or sarcoidosis with necrosis of the granulomas and of the vessels." There has, as yet, been no definitive answer to the questions that he raised. To determine whether there is a relationship between necrotizing sarcoid granulomatosis and nodular sarcoidosis in order to ascertain whether the current prevailing opinion that they are related is correct. The world's literature on necrotizing sarcoid granulomatosis from 1973 to 2013 and nodular sarcoidosis from 1952 to 2013 was critically reviewed. One hundred three cases of necrotizing sarcoid granulomatosis and 111 cases of nodular sarcoidosis were found suitable for individual case analysis. The data showed a striking overlap in the clinical, radiologic, and pathologic features of both entities, strongly supporting the conclusion that necrotizing sarcoid granulomatosis is a previously unrecognized manifestation of sarcoidosis and is essentially the same as nodular sarcoidosis. It is proposed that use of necrotizing sarcoid granulomatosis as a diagnostic term be discontinued and replaced by sarcoidosis with necrotizing sarcoid granulomatosis pattern provided that an infectious etiology can be reasonably excluded. Our concept of sarcoidosis should now be expanded to recognize that there is a continuous spectrum of necrosis ranging from minimal to extensive.

Sarcoidosis associated with pseudo papillary pancreatic tumor

Introduction: the sarcoidosis is an idiopathic multisystem inflammatory disease characterized by the presence of non-caseating granulomas in the affected organs. A clear association between sarcoidosis and malignancies has been reported. cancer can occur in patients with an established diagnosis of sarcoidosis and sarcoidosis can subsequently develop in a cancer patient. Malignancy can also be associated with the occurrence of sarcoid reactions. case report: We report the case of sarcoidosis/sarcoidlike reaction associated with pseudopapillary pancreatic tumor. conclusion: this case report emphasizes the need to add sarcoidosis in the differential diagnosis of lung lesions associated with pancreatic tumors.

Sarcoidosis-Lymphoma Syndrome: A Spectrum of One Disease

Lymphoma might occur in association with sarcoidosis or sarcoidosis might be combined with lymphoma, in so called (“sarcoidosis-lymphoma syndrome”). This syndrome is well reported in medical literature. The question, which one starts before is difficult to answer, as in some cases sarcoidosis starts first then is followed by lymphoma but in other cases during the course of lymphoma sarcoid reaction might be seen. In the present report, we describe a case of 60 years male patient that is presented with a rash with classical sarcoid pathology that overtime changes into typical lymphoma ended with death.

胃粘膜および所属リンパ節にサルコイド反応を伴った早期胃癌の1例

胃粘膜および所属リンパ節にサルコイド反応を伴った早期胃癌の1例

Mycobacterium tuberculosis as a sarcoid factor? A case report of family sarcoidosis.

Patient: Male, 26Final Diagnosis: SarcoidosisSymptoms: Disseminated lung parenchymal changesMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Sarcoidosis is a granulomatous inflammatory disease that is induced by unknown antigen(s) in a genetically susceptible host. Although the direct link between Mycobacterium tuberculosis (MTB) infection and sarcoidosis can be excluded on the basis of a current knowledge, the non-infectious mechanisms may explain the causative role of mycobacterial antigens. The co-incidence of tuberculosis (TB) and sarcoidosis, and higher incidence of mycobacterial DNA in biological samples of sarcoid patients, have been reported by many authors.Case Report:We present a case in which MTB infection in 1 family member triggered a sarcoid reaction in the infected subject and 2 other non-infected family members. We discuss different aspects of diagnosis and differentiation, as well as up-to-date hypotheses on the possible mechanisms leading to sarcoid inflammation in patients exposed to MTB.Conclusions:This case series documents the possibility of familial spreading of sarcoidosis, and points to MTB as a potential etiological factor.

Lung cancer with sarcoid reaction in the lymph nodes following chemoradiotherapy

This report describes a case of lung cancer with sarcoid reaction following chemoradiotherapy, showing false-positive accumulation of (18)F-fluorodeoxyglucose on positron-emission tomography in a 55-year-old man. Treatment-related sarcoid reaction should be considered when the accumulation of (18)F-fluorodeoxyglucose shows rapid extension in the course of treatment.

Sarcoïdose médiastinale dans un contexte oncologique : apport de la ponction aspiration guidée par échoendoscopie

IntroductionSarcoidosis and sarcoid reactions have been previously reported in association with cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive test for investigating mediastinal lymph nodes Patients and methodsWe conducted a retrospective review of 54 patients undergoing EUS-FNA in a cancer institute for suspected metastatic mediastinal lymph nodes showed by CT-imaging or positron emission tomography (PET). Patients with non-caseating granuloma identified by EUS-FNA were included ResultsEUS-FNA identified non-caseating granuloma in seven out of the 54 included patients. Most of them had positive PET. One patient had a prior history of sarcoidosis before the diagnosis of cancer. Another patient developed micrometastasis associated with sarcoid-like reaction. There was no adverse outcome associated with the EUS-FNA procedure ConclusionsSarcoidosis must be included in the differential diagnosis of patients with a history of malignancy who develop mediastinal lymphadenopathy. EUS-FNA is a safe and minimally invasive test to obtain tissue diagnosis

Clear cell adenocarcinoma of the ovary with a sarcoid reaction in the spleen and regional lymph nodes: A case report

•Preoperative diagnosis of sarcoid reactions is important to avoid overtreatments.•Sarcoid reactions could act as a favorable prognostic factor in ovarian cancer.

Immunopathogenesis of Sarcoidosis and Risk of Malignancy: A Lost Truth?

The hypothesis of a relationship between sarcoidosis and malignancy was firstly formulated in 1972 by Brincker. He documented an association of sarcoid reactions or sarcoidosis with 19 lymphomas and associated malignancies. Based on various epidemiological studies, for more than 20 years sarcoidosis has been considered as a condition at increased risk for cancer, particularly lymphoproliferative disorders. The existence of a sarcoidosis-lymphoma syndrome was therefore proposed, highlighting, as a potential mechanism, the uncontrolled lymphocyte proliferation and mitotic activity. A reduced ability to eliminate an antigen and chronic inflammation have been suggested as triggering events. Leading to a reduced tumor immune surveillance, a diminished myeloid dendritic cells (mDC) function, despite up-regulated co-stimulatory and maturation markers, was also raised as potential mechanism. However, some subsequent studies have questioned the presence of a close association between the two entities and have explained those previously published as the result of selection bias and misclassification. Recently, a Swedish population-based cohort study documented a significant overall excess incidence of cancer among sarcoidosis patients, especially those with multiple hospitalizations or admission in older age, emphasizing again a potential neoplastic risk. Therefore, currently, whether these patients have an increased risk of developing malignant lesions is still debated. Larger and unbiased studies are needed before drawing definite conclusions.